Saturday, 31 January 2015

The NHS in East Devon >>>>>>>>>>>>>>>>>>>>> CCG's "Transforming Community Services" consultation extended to 24th February

There are concerns about the future of the NHS - with the looming of various elections: 
both national
The letters NHS stand for a litany of blame, waste and pessimism - Telegraph
NHS 'spin bill' soars as crisis grows - Telegraph
A&E crisis: more 12 hour trolley waits in January than whole of 2013/2014 - Telegraph
Chaos ahead as hospital chiefs veto NHS funding plan - Telegraph

... and local:


Comment on the EDA website:

To me it seems to make sense to find opportunities to be more efficient and to implement changes to make these happen.

And clearly with a £14m+ deficit last year and a bigger one this year, then (leaving aside the accumulated deficit) one of three things needs to happen:

a. Increase the local budget by £15m+ per year in order to continue giving the level of services required by the local population;

b. Make straight forward cuts in services to save £15m+ in order to balance the budget in the future – which implies lower levels and quality of services, longer waiting times, no treatment for less serious conditions etc. etc.

c. Find ways to eliminate wastage and improve efficiencies in order to make savings whilst maintaining or improving the level of services, waiting times etc.

And of course, to address the accumulated deficit they may have to have a one-off injection of money or make further cuts to claw it back.

So NEW Devon CCG seems to be trying to do the right thing, but apparently in the wrong way as they are creating a lot of high emotion and objections, perhaps because:

1. They have left it too late – if it became apparent in 1Q 2013 that the costs of services were (say) £3.5m PER QUARTER above budget, then they should have started to identify ways to reduce wastage and improve efficiency in 2Q 2013 not in 4Q 2014.

2. They are keeping the reasoning secret – I think that we all understand that there is not enough money to do everything at tip-top quality, and compromises need to be made. If the CCG want buy-in from both local government and the local population, then they need to explain their reasoning. Of course, they won’t please all of the people all of the time – indeed are likely to please none of the people none of the time – but that is often the consequence of compromise, that the difficulties are spread evenly. But if you keep the reasoning secret, people then wonder what the real motives are and whether the CCG is being honest and open.

3. They leave it to the last minute – the CCG reports have been produced at the last minute (fact) and the appearance (supposition) is that this is to limit the degree of scrutiny and get the changes bulldozed through. However, the NHS is one of the issues closest to most of our hearts (because we all worry that the NHS services need to be there for us if / when we need them), and this seems always likely to back-fire, creating more uncertainty about motives.

4. The solution is disjointed from the objectives – it seems to me that the objectives (e.g. how close should beds be to where the patients live) is not well documented, and so the design of services can be seen as somewhat arbitrary because the requirements are unclear. Of course there will be tradeoffs, but to e.g. centralise all beds without understanding any distance objectives leads inevitably to questions about whether the proposed changes are fit for purpose.

5. Disjointedness – we are told that OSM Hospital will lose all its beds, and that the future is very uncertain – then we are told that it will have a new specialised use. The planning for the NHS needs to be more joined up if we are to have confidence that it is being well run.

Is this the real reason our community hospitals are being cut? | East Devon Watch
Devon NHS body takes 'urgent measures' as finances worsen | Exeter Express and Echo


NHS bosses are allowing people more time to have their say over controversial proposals to shake-up community health services across East Devon and beyond.

In September the North, East and West Devon Clinical Commissioning Group (CCG), which is £14m in debt, announced its aim to improve care in the community, increasing the number of healthcare professionals and therefore close hospital beds to fund this change. The CCG launched a 12-week consultation process in September which was due to end in December, but it has now announced an extension to its consultation period until February 15.

Under the plans, all inpatient beds will close at Ottery St Mary, Axminster and Crediton hospitals, as well as Ottery’s Minor Injuries Unit (MIU). Meanwhile, Exmouth, Honiton and Tiverton will become Urgent Care Centres serving the surrounding communities.

The CCG’s Transforming Community Services document for Eastern Devon explains that the healthcare vision is for a model where community healthcare is more closely integrated with social care.

NHS bosses extend public consultation over controversial Devon hospital beds closure proposals | Exeter Express and Echo


Doctors’ surgeries in Exeter, Mid and East Devon are opening their doors to more people this weekend as the health service struggles to cope with sustained pressure on emergency services. Hundreds of extra GP appointments have been made available across the region to divert patients away from reporting to A&E, where record numbers have led to the worst performance in a decade.


A TOP NHS official has promised to reveal the financial reasoning behind controversial proposals to get rid of some community hospital beds and Minor Injuries Units (MIUs) across East Devon, and look into alternative options.

Councillors, GPs and volunteers met to discuss, and challenge proposals first announced in September by the Northern, Eastern and Western Devon Clinical Commissioning Group (CCG), which is £14m in debt.

The CCG said its aim was to improve care in the community, increasing the number of healthcare professionals and therefore close hospital beds to fund this change.


HEALTH bosses have been urged to listen to volunteer groups, as well as patients themselves, in order to ensure that community services are protected at Sidmouth’s Victoria Hospital. NHS chiefs were warned that the town could be “swamped” with extra patients if hospital beds are relocated to Sidmouth as planned.

Local representatives pressed the Northern Eastern and Western Devon Clinical Commissioning Group (NEW Devon CCG) to utilise its “best asset” over the next few months, by involving the Victoria Hospital Comforts Fund and Patient Participation Group in discussions about its ‘transforming community services’ proposals.

The CCG announced before Christmas that it would extend its public consultation period into the new year, following an unprecedented response from residents in Ottery St Mary, Axminster and Sidmouth, where the cuts will be felt most sharply. Under the proposals, Sidmouth will gain in-patient beds from other hospitals, but lose its minor injuries unit, while nearby Ottery is set to lose all its beds as well as its minor injuries unit.

As part of the consultation process, health bosses have invited county councillors and representatives of League of Friends organisations from across East Devon to form a ‘stakeholder group’, working closely with the CCG over the coming weeks. The group met for the first time on Wednesday, where a number of possible alternatives to the CCG’s preferred options were discussed. ‘Stakeholders’ will meet with CCG chiefs on a regular basis and could hold a degree of influence in helping to change the controversial plans.

Speaking at the meeting, Comforts Fund chairman Graham Vincent said he was pleased that the group was being given the chance to play a part. “Someone from the voluntary sector should be involved,” he said. “The League of Friends groups are the best assets that the NHS has. They supply the bricks and mortar, they build the hospitals and cover maintenance costs. And yet, they are not included in major decisions.”

Di Fuller, Sidmouth Patient Participation Group chairperson, who was invited to speak at the meeting but is not currently a ‘stakeholder,’ said she would also be willing to take part in further discussions. “We have had various consultation meetings in Sidmouth and there has been a huge public outcry with regard to maintaining the facilities that we currently have. We realise that we are actually going to increase the number of beds we have, though the demographic change in Sidmouth justifies that anyway. But there are real concerns that the loss of beds in other areas will leave Sidmouth swamped.” She also said the PPG would be a useful group to represent patient views and bring forward potential problems caused by changes to community care.

Various possibilities were discussed during the meeting, with a checklist of potential options drawn up for the group to explore. Though no formal timescale has been placed on the stakeholder group’s work, the CCG has confirmed that its public consultation will end on February 24th.

Speaking at the end of the meeting, former Axminster GP Dr James Vann said it was important that the group acts quickly to calm the public mood. He said: “Our staff are not being well looked after and the CCG has a responsibility to produce a result quickly, having made public a proposal some months ago. You [the CCG] started the ball rolling but it cannot go on and on and on. There is a lot of suffering happening right now because of that statement in September.”

SIDMOUTH: Hospital could be swamped - View from Sidmouth


THE Government’s health sector regulator is investigating the decision by NHS bosses to commission the Royal Devon & Exeter Foundation Trust (RD&EFT) for its community services in East Devon instead of Northern Devon Healthcare NHS Trust (NDHT).

Up until November the Northern, Eastern and Western Devon Clinical Commissioning Group (CCG) commissioned the NDHT to provide community services, which includes community hospitals, physiotherapy and community nursing.

It subsequently announced the RD&EFT as its preferred provider instead, after launching a procurement process to ensure community based delivery system designed to achieve a step change in integrated care.

Today, health watchdog Monitor announced it would be investigating this decision following a complaint from the NDHT.

If Monitor decides to uphold the complaint and the CCG is forced to put the service out to tender, there is a chance it could be taken over by a private company.

Watchdog to investigate health chiefs’ decision to swap East Devon health care providers | Exeter Express and Echo
Devon health bosses welcome investigation into “flawed” decision to axe trust as provider of community services in East Devon | Exeter Express and Echo
BBC News - £100m health contract investigation in Devon
Updated: Competition regulator to probe NEW Devon £100m contract award | HSJ Local | Health Service Journal


Tiverton and Honiton MP, Neil Parish said he would be asking officials from Monitor to reverse their decision to investigate. “I’m not happy about the investigation into this decision, it’s a waste of public money and could delay the process,” he said. “After the consultation that’s already happened with local people and doctors, it’s nonsense now to throw everything up in the air.”

He added: “I am in favour of the RD&EFT taking on the contracts – it seems to make sense that the whole process of patients being transferred from the RD&E to community hospitals will run more smoothly. And it should help with protecting our community hospitals as well.”

A spokesperson for the NDHT said that the Care Quality Commission described its integrated community health and social care services as “the best they had ever seen” during the chief inspector of hospitals four-day inspection of the Trust in July.

The Trust has run the community services in East Devon since they were transferred from NHS Devon in April 2011.

MP blasts inquiry into who should run East Devon's community hospitals | Exeter Express and Echo


HEALTH bosses have reaffirmed the reasons behind their proposals to cut community services at Sidmouth’s Victoria Hospital, but say they are still willing to review options before reaching a final decision. New information detailing the NEW Devon Clinical Commissioning Group’s plans for “transforming” community services was released last week, as part of its extended consultation period.

Following a meeting of invited ‘stakeholders’ – including senior councillors and Comforts Fund representatives – held earlier this month, the CCG produced a supplementary document setting out the reasons behind its proposals to remove the minor injuries unit at the Victoria Hospital.

The CCG – the NHS body responsible for assessing local healthcare needs and buying suitable services – believes in-patient services must remain in Sidmouth, Honiton and Seaton to cope with the towns’ elderly and ‘at risk of admission’ populations. It says the total number of people aged 85 and above is “significantly greater” in Sidmouth than anywhere else in East Devon, with the high incidence of dementia and other common conditions putting the town’s population at the greatest risk.

But opposers remain furious that the CCG is intending to remove the hospital’s minor injuries unit, and, as reported in last week’s Pulman’s View, fear that it could be “swamped” by the extra demand for beds.

Following the public outcry from the communities facing the deepest cuts, the CCG is reassessing its decision and now says it has an “open mind” about the proposals. An initial public consultation period during the autumn has been extended to February 24th, and the recently formed ‘stakeholder’ group will work closely with health bosses over the next few weeks.

It is possible that revisions could be made to the existing proposals, published in September under the banner of ‘Transforming Community Services’. By consolidating its in-patient units from five sites down to three, the CCG says it can save £560,000. It is already planning for an end-of-year deficit of £14.7million.

A supplementary report issued by the CCG last week said: “At the current time, we believe that our proposed option provides the best way to configure in-patient facilities because it meets the criteria we have considered as part of our provisional decision making, and in particular best meets the need for in-patient facilities in the eastern locality. For this reason, we are not currently minded to propose any of the potential alternatives … however, we retain an open mind in relation to the configuration of in-patient services in the eastern locality and will reconsider our proposed option in light of feedback received in response to the consultation and other stakeholder engagement.”

For more information about the CCG’s proposals, visit 
Transforming Community Services within NHS NEW Devon CCG


“At a well attended meeting to discuss progress in the fight to maintain in-patient beds at Axminster hospital, Cllr Andrew Moulding (wearing both his Town and County councillor hats) spoke to concerned residents about his representations to the Devon CC Health and Wellbeing OSC. He made clear his feelings on the matter to the OSC and stated that his only job as a Councillor was to convey the feelings, views, anger and frustration of Axminster people over the shameful way in which the CCG and NDHT had conducted themselves, with misleading figures, loaded and biased consultations and the heavy handed (and expensive) use of lawyers to force a decision through…

A member of the public replied that the whole situation was ” kafka-esque ” and that despite public passion and anger and a huge response ( against the establishment view ) to the Consultation document, it seems as if the public's wishes and views were simply ignored… How do we change this state of affairs…

“To a Louse”: with particular reference to Councillor Moulding, Axminster Hospital and Knowle Relocation | East Devon Watch

See also:
Futures Forum: Meeting to consider health proposals for East Devon... 7pm Wednesday 14th January... making informed choices >>> East Devon's Health Profile
Futures Forum: Meeting to consider health proposals for East Devon: 7pm Weds 14th January: booking essential
Futures Forum: The future of health services in East Devon... "challenged health economies"
Futures Forum: The future of health services in Sidmouth... "The MIU closure is not about cash, but about the provider not being able to deliver."
Futures Forum: Sidmouth's ageing population: "Without urgent investment in coastal communities, some areas will struggle to retain the working age families needed to fuel the economies of towns dominated by old people’s homes."
Futures Forum: The future of health services and how they will affect Sidmouth: meeting at Stowford Rise Community Centre.... Tuesday 11th November
Futures Forum: Community hospitals in East Devon: consultation on NHS proposals begins
Futures Forum: Healthcare in Devon: consultation 'dangerous' and 'wishy washy'
Futures Forum: Healthcare in Devon: proposed framework for services now open to consultation
Futures Forum: A more dementia-friendly Devon

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